Provider Demographics
NPI:1376066712
Name:MANGIMELLI, JAMES (AUD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MANGIMELLI
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 FARAON ST STE 160
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3829
Mailing Address - Country:US
Mailing Address - Phone:816-671-4840
Mailing Address - Fax:
Practice Address - Street 1:5301 FARAON ST STE 160
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3829
Practice Address - Country:US
Practice Address - Phone:816-671-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2326231H00000X
CA3260231H00000X
MO2017033354231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist